Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, 20, Ilsan-Ro, Wonju 26426, Republic of Korea.
Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul 08308, Republic of Korea.
Medicina (Kaunas). 2024 May 28;60(6):882. doi: 10.3390/medicina60060882.
: Acetabular fractures, though infrequent, present considerable challenges in treatment due to their association with high-energy trauma and poor prognoses. Posterior wall fractures, the most common type among them, typically have a more favorable prognosis compared to other types. Anatomical reduction and stable fixation of the posterior wall are crucial for optimal treatment outcomes. This study aimed to biomechanically compare three commonly used fixation methods for posterior wall fractures of the acetabulum-a conventional reconstruction plate, a spring plate, and a 2.7 mm variable angle locking compression plate (VA-LCP). : The study utilized 6 fresh-frozen cadavers, yielding 12 hemipelvises free from prior trauma or surgery. Three fixation methods were compared using a simple acetabulum posterior wall fracture model. Fixation was performed by an orthopedic specialist, with prebending of plates to minimize errors. Hemipelvises were subjected to quasi-static and cyclic loading tests, measuring fracture gap, stiffness, and displacement under load. : It showed no significant differences in fracture gap among the three fixation methods under cyclic loading conditions simulating walking. However, the conventional reconstruction plate exhibited a greater stiffness compared to the spring and variable angle plates. Fatigue analysis revealed no significant differences among the plates, indicating a similar stability throughout cyclic loading. Despite differences in stiffness, all three fixation methods demonstrated adequate stability under loading conditions. : While the conventional reconstruction plate demonstrated a superior stiffness, all three fixation methods provided sufficient stability under cyclic loading conditions similar to walking. This suggests that postoperative limitations are unlikely with any of the three methods, provided excessive activities are avoided. Furthermore, the variable angle plate-like the spring plate-offers an appropriate stability for fragment-specific fixation, supporting its use in surgical applications. These findings contribute to understanding the biomechanical performance of different fixation methods for acetabular fractures, facilitating improved surgical outcomes in challenging cases.
髋臼骨折虽不常见，但由于其与高能创伤和不良预后相关，因此在治疗方面存在较大挑战。其中，后壁骨折是最常见的类型，与其他类型相比，预后通常更为有利。解剖复位和后壁的稳定固定是获得最佳治疗效果的关键。本研究旨在对髋臼后壁骨折的三种常用固定方法（传统重建钢板、钢板弹簧和 2.7mm 可变角锁定加压钢板[VA-LCP]）进行生物力学比较。
该研究使用了 6 个新鲜冷冻的尸体，共获得 12 个无既往创伤或手术史的半骨盆。使用简单的髋臼后壁骨折模型比较了三种固定方法。由骨科专家进行固定，预弯钢板以尽量减少误差。对半骨盆进行准静态和循环加载试验，在模拟行走的循环加载条件下测量骨折间隙、刚度和载荷下的位移。
结果显示，在模拟行走的循环加载条件下，三种固定方法的骨折间隙无显著差异。然而，与钢板弹簧和可变角钢板相比，传统重建钢板的刚度更大。疲劳分析表明，三种钢板之间无显著差异，表明在整个循环加载过程中具有相似的稳定性。尽管刚度存在差异，但在加载条件下，所有三种固定方法均显示出足够的稳定性。
虽然传统重建钢板表现出较高的刚度，但在类似于行走的循环加载条件下，所有三种固定方法均提供了足够的稳定性。这表明，在避免过度活动的情况下，任何三种方法术后都不太可能出现限制。此外，可变角钢板（类似于钢板弹簧）为特定骨折块的固定提供了适当的稳定性，支持其在手术应用中的使用。这些发现有助于理解髋臼骨折不同固定方法的生物力学性能，从而改善复杂病例的手术结果。
